In this guide15 sections
- Key Points
- What Is Wound Dehiscence?
- Wound Dehiscence Symptoms: Signs a Wound Is Opening
- When Does Wound Dehiscence Happen After Surgery?
- What Causes Wound Dehiscence?
- Wound Dehiscence Risk Factors
- Wound Dehiscence After Cosmetic Surgery
- Wound Dehiscence Treatment: How Do You Fix Dehiscence?
- What to Do If Your Wound Opens at Home
- How Long Does a Dehisced Wound Take to Heal?
- How to Prevent Wound Dehiscence
- How We Reduce the Risk of Wound Problems at Centre for Surgery
- Frequently Asked Questions
- Worried About Healing After Surgery?
- References
Key Points
- What is wound dehiscence? It is when a surgical incision that was closed with stitches, staples or glue partly or completely opens again before it has healed.
- Most dehiscence after cosmetic surgery is superficial. A small gap in the skin, often where two scar lines meet, usually heals with dressings over a few weeks.
- Full-thickness dehiscence is different. If the deeper layers separate, or anything bulges through the wound, it is an emergency that needs same-day surgical review.
- It usually happens in the first one to three weeks, when the wound is at its weakest, and the commonest triggers are tension on the wound and infection.
- Smoking is the biggest risk you can change. A meta-analysis of 140 studies found smokers were about twice as likely to have wound dehiscence or delayed healing.
- Other risk factors include diabetes, a high BMI, anaemia, poor nutrition, steroid medicines, coughing or straining, and operations that remove a lot of skin.
- A wound that is gapping, leaking, red, hot or smelly should be seen by your surgical team the same day rather than left until your next appointment.
Most surgical wounds heal without any problems. In the days after an operation the edges of the incision knit together, and by around two weeks the stitches can usually come out. Occasionally, though, part of a wound pulls apart before it has healed. The medical name for this is wound dehiscence, and the word itself simply means “to gape” or “to split open”. Seeing a wound open can be alarming, but most cases after cosmetic and plastic surgery are small, superficial and heal well with the right care.
This guide explains what surgical wound dehiscence is, the signs to look out for, why wounds open, who is most at risk, and how dehiscence is treated. It sits alongside our overview of the risks and complications of cosmetic surgery and our practical guide on how to reduce complications after plastic surgery. If you smoke or vape and are planning an operation, our guide to smoking and cosmetic surgery explains why stopping is the single most useful thing you can do for your wound.
What Is Wound Dehiscence?
Wound dehiscence is the partial or complete separation of the edges of a surgical wound that had been closed. An international consensus document from the World Union of Wound Healing Societies defines surgical wound dehiscence as the separation of the margins of a closed surgical incision, with or without exposure of the tissues, organs or implants underneath (Wounds International consensus statement ↗). The US National Library of Medicine’s StatPearls review ↗ describes it in similar terms as a failure of proper wound healing.
The meaning of dehiscence in practice depends on how deep the opening goes. Clinicians describe two broad types:
- Superficial (partial) dehiscence: only the skin and the fat just beneath it open. The deeper layer, such as the muscle sheath (fascia) in the abdomen, stays closed. This is by far the commonest type after cosmetic surgery, and it is often called minor wound dehiscence when the gap is only a few millimetres.
- Full-thickness (complete) dehiscence: all the layers of the wound separate, including the deep layer. In the abdomen this is sometimes called a burst abdomen, and it is a surgical emergency.
Wound dehiscence vs evisceration
Evisceration is the most serious end of the spectrum. It means organs, usually loops of bowel, push out through a full-thickness abdominal wound. It is rare, and it is mainly a complication of major operations inside the abdomen, such as bowel surgery, rather than cosmetic operations on the abdominal wall. If it ever happens, cover the area with a clean, damp cloth or dressing, do not try to push anything back in, lie down with the knees bent and call 999.
Wound Dehiscence Symptoms: Signs a Wound Is Opening
Sometimes the opening is obvious. At other times the first sign is a change in how the wound looks or feels. Signs of wound dehiscence include:
- a visible gap between the wound edges, or stitches that have pulled through or broken
- a sudden increase in fluid from the wound, particularly clear pink or blood-stained fluid that soaks a dressing
- a feeling of something giving way, popping or tearing at the wound, often after a cough, sneeze or lift
- a small dark or yellow area in the wound line that does not heal, sometimes with a scab that lifts away to reveal an open area
- increasing pain, swelling, redness or warmth around the wound
- pus, a bad smell or a high temperature, which point to infection
- a new bulge under or through the wound
It is worth knowing what is normal too. Mild pinkness along the scar line, some bruising, a little clear fluid in the first day or two and a slightly raised, firm ridge under the scar are all part of ordinary healing. If you are not sure, take a photo and contact your surgical team: comparing pictures over a few days is often the quickest way to tell a healing wound from one that is breaking down.
When Does Wound Dehiscence Happen After Surgery?
Wound dehiscence is most likely in the first few weeks after surgery. In the first week the wound relies almost entirely on its stitches, as the new tissue bridging the gap is still weak. The StatPearls review notes that dehiscence typically appears around five to eight days after an operation, which is when that early tissue is at its most fragile.
After cosmetic surgery the timing often stretches a little later, to around one to three weeks. Small areas of superficial breakdown frequently show up when dissolving stitches start to lose strength or when a scab lifts away, and they are most common at points under the most tension, such as the junction where the vertical and horizontal scars meet after an anchor-type breast reduction or breast lift. A wound that has healed and then reopens months later is unusual and usually has a different cause, such as a stitch working its way to the surface.
What Causes Wound Dehiscence?
Researchers who have studied surgical wound dehiscence group its causes into two kinds: mechanical factors that pull a wound apart, and physiological factors that stop it healing properly[1][2]. In most cases more than one is involved.
Tension on the wound
A wound under tension is more likely to open. Tension can come from the operation itself, for example when a large amount of skin is removed in a tummy tuck, arm lift or thigh lift so that the edges are closed under stretch. It can also come from what happens afterwards: coughing, sneezing, vomiting, straining on the toilet, lifting, stretching too far, or standing fully upright too soon after an abdominoplasty. A large Dutch study of 363 people with abdominal wound dehiscence and 1,089 matched controls found that coughing after surgery, along with wound infection, was one of the strongest independent predictors[3].
Infection
Infection is the single most important physiological cause. Bacteria inflame the tissue, break down the early collagen that holds the wound together and weaken the stitches’ grip. A review of the literature on surgical wound dehiscence found that wound infection and obesity were the risk factors reported most consistently[1]. A wound that becomes red, hot, more painful and starts to leak cloudy fluid in the first week or two may be infected, and infection and dehiscence often appear together.
Poor blood supply
Healing tissue needs oxygen. Anything that reduces blood flow to the wound edges, such as smoking, tight dressings or garments, a seroma (a collection of fluid under the skin) or a haematoma (a collection of blood) pressing from below, makes the edges more likely to break down. When a small area of skin at the wound edge dies from lack of blood supply, it turns dark and later separates, leaving an open area that looks like dehiscence. Our guides to seroma after a tummy tuck and breast haematoma after surgery explain how these collections are recognised and treated.
Wound Dehiscence Risk Factors
Some risk factors are part of who you are or the operation you need. Others can be changed before surgery, and those are the ones that matter most in planning.
Smoking and vaping
Smoking is the most important modifiable risk factor for wound problems. Nicotine narrows the small blood vessels that feed the skin, and carbon monoxide reduces how much oxygen the blood can carry. The best evidence comes from a 2012 systematic review and meta-analysis in the Archives of Surgery ↗ of 140 cohort studies including 479,150 patients. Compared with non-smokers, smokers had roughly twice the odds of delayed healing and dehiscence and more than three times the odds of tissue necrosis. Former smokers did better than current smokers but still had a slightly higher risk than people who had never smoked, and in the randomised trials it included, stopping smoking before surgery reduced wound infections[4].
In practice, this is why plastic surgeons ask patients to stop smoking and using nicotine products well before and after surgery. Nicotine replacement patches, gum and vapes still contain nicotine, so ask your surgeon what is safe for you.
Diabetes and blood sugar
High blood sugar slows healing and weakens the body’s defences against infection. A meta-analysis of 94 studies found that diabetes raised the odds of surgical site infection by about half across many different operations[5], and infection is closely linked to dehiscence. If you have diabetes, good control in the weeks before surgery matters, and your surgeon may ask for a recent HbA1c blood test.
BMI and body weight
A higher body mass index puts more weight and tension on a wound, and fatty tissue has a relatively poor blood supply. In a series of 205 patients having body contouring after major weight loss, smoking combined with older age, a BMI above 30 and the amount of tissue removed led to significantly more wound healing problems[6]. Our guide to BMI and cosmetic surgery eligibility explains the thresholds used for different operations and why they exist.
Anaemia, nutrition and other health factors
Wounds need protein, vitamins and a healthy blood count to heal. Other recognised risk factors include:
- anaemia (a low red blood cell count), which reduces oxygen delivery to the wound
- poor nutrition or low protein intake, including after very rapid weight loss
- long-term steroid medicines and some drugs that suppress the immune system
- previous radiotherapy to the area
- chronic lung disease, which brings more coughing
- older age
- emergency rather than planned surgery
Several of these can be improved before an elective operation, which is one of the reasons a thorough pre-operative assessment, including blood tests where appropriate, is part of safe planning.
Wound Dehiscence After Cosmetic Surgery
Wound dehiscence after cosmetic surgery is usually superficial, small and confined to one part of the scar. The operations where it is seen most often are the ones that remove skin and close the wound under tension.
After a tummy tuck
A tummy tuck lifts a large flap of skin and fat, removes the excess and closes a long wound across the lower abdomen. The centre of the scar, which sits furthest from the blood supply and under the most tension, is the commonest place for a small area of breakdown. The risk is higher after massive weight loss: in an Italian series of 213 abdominoplasty patients who had lost a large amount of weight, delayed wound healing affected 27.7%, and smoking, a higher BMI and anaemia before surgery were among the factors linked to complications[7]. Walking slightly bent forward for the first week or two, avoiding lifting and supporting the abdomen with a pillow when you cough all reduce strain on the scar, as our guides to tummy tuck recovery, how to walk after a tummy tuck and sleeping after a tummy tuck explain. An apronectomy carries similar considerations.
After breast reduction and breast lift
After a breast reduction or an anchor-pattern breast lift, the point where the vertical scar meets the scar in the fold under the breast (the T-junction) is the classic place for a small wound to open. Smoking has a particularly strong effect here. A 2016 meta-analysis in PLOS ONE ↗ of 16 studies and 10,593 breast reduction patients found that smokers had 2.73 times the odds of wound dehiscence compared with non-smokers[8]. Most of these openings are a few millimetres to a centimetre or two across and heal with dressings. Our guides to breast reduction scars, the anchor (inverted-T) breast lift and breast lift scars describe how these scars normally heal.
After arm lift, thigh lift and body lift
Arm lifts, thigh lifts and body lifts all involve long wounds in areas that move a great deal. Small areas of wound breakdown are among their commonest complications, and they usually heal with dressings. The guides to arm lift scars and thigh lift scars explain how movement is limited in the early weeks to protect the wound.
After labiaplasty and other procedures
Wound separation is also one of the recognised complications of labiaplasty, more often after a wedge technique than a trim, as discussed in our comparison of trim vs wedge labiaplasty and our labiaplasty recovery guide. After male chest surgery, our guide on how to prepare for gynecomastia surgery explains how steroid and androgen use affects wound healing.
Wound Dehiscence Treatment: How Do You Fix Dehiscence?
Treatment depends on how deep the opening is, how large it is, whether there is infection and where it is. Your surgical team will examine the wound before deciding.
Superficial dehiscence
Most small, superficial openings are left to heal from the base upwards, which is called healing by secondary intention. The wound is cleaned, any loose or dead tissue is gently removed, and it is dressed regularly with dressings chosen to keep it moist and absorb fluid. If there are signs of infection, a swab may be taken and antibiotics given. These wounds fill in steadily with new tissue over a few weeks and then the skin closes over the top.
Can you resuture a dehisced wound?
Sometimes, but not usually straight away. A wound that has been open for more than a few hours is contaminated with skin bacteria, and stitching it closed can trap infection inside. For that reason surgeons generally avoid re-stitching an opened surgical wound immediately. If the opening is large and clean, the surgeon may close it a few days later, once it is free of infection and healthy tissue is visible (a delayed primary closure), or allow it to heal and revise the scar later if needed. Full-thickness dehiscence of the abdominal wall is different: it needs urgent assessment and usually a return to theatre to repair the deep layer.
Negative pressure wound therapy
For larger or slower-healing wounds, negative pressure wound therapy, sometimes called a vacuum dressing, may be used. A foam or gauze dressing is sealed over the wound and connected to a small pump that applies gentle suction, which removes fluid and helps the wound contract. It is also sometimes placed over closed incisions straight after surgery in people at high risk. The evidence for that preventive use is mixed. A 2022 Cochrane systematic review ↗ of 62 randomised trials with 13,340 participants found that using negative pressure dressings on closed surgical wounds probably reduces wound infection (8.7% compared with 11.75% with standard dressings), but probably makes little or no difference to dehiscence itself (6.62% compared with 6.97%), and it may cause more skin blisters[9]. That is why it is used selectively rather than for everyone.
What to Do If Your Wound Opens at Home
If you notice a gap in your wound after you have gone home:
- Stay calm and look at it in good light. Most openings after cosmetic surgery are small and superficial.
- Cover it. Wash your hands and place a clean, dry, non-fluffy dressing over the area. Do not apply creams, powders or home remedies.
- Do not try to close it yourself with tape, glue or by pressing the edges together.
- Take a photo if you can, so your team can see how it looks.
- Contact your surgical team the same day, even if it is small. Early review means faster healing and a better scar.
- Call 999 if anything is bulging through the wound, there is heavy bleeding, or you feel very unwell, faint or breathless.
Should you cover wound dehiscence? Yes: a clean dressing protects the open area from infection and absorbs fluid until it can be assessed. Wound dehiscence treatment at home is then usually a matter of following the dressing plan your team gives you, keeping the area clean and dry between changes, and attending every follow-up.
How Long Does a Dehisced Wound Take to Heal?
It depends on the size and depth of the opening, your general health and whether there is infection. A small superficial opening a few millimetres across often heals in one to three weeks. A larger area healing by secondary intention can take four to eight weeks or longer. The healing stages are the same as for any open wound: the base fills with healthy pink-red tissue, the wound contracts and gets smaller, and finally new skin grows in from the edges.
A wound that has healed by secondary intention usually leaves a wider scar than the original line. Scars keep improving for 12 to 18 months, and if the final result is not satisfactory, the scar can often be improved later with scar revision. Our guide on how to minimise scars after cosmetic surgery covers silicone, sun protection and massage once the wound is fully closed, and the guide to hypertrophic scars explains what to do if a scar becomes raised.
How to Prevent Wound Dehiscence
Not every case can be prevented, but the risk can be reduced a great deal, both by you and by your surgical team.
Before surgery
- Stop smoking and all nicotine products for the period your surgeon advises before and after the operation.
- Reach a stable, healthy weight before planned body contouring rather than straight after rapid weight loss.
- If you have diabetes, work with your GP to get your blood sugar well controlled.
- Eat enough protein and treat anaemia if blood tests show it.
- Tell your surgeon about every medicine and supplement you take, including steroids.
- Treat a persistent cough or chest infection before surgery, and reschedule if you are unwell.
After surgery
- Follow your restrictions on lifting, stretching and exercise, usually for around four to six weeks.
- Support the wound with a pillow or your hands when you cough, sneeze or laugh.
- Avoid straining on the toilet; eat fibre, drink plenty of water and ask about a stool softener if you are taking strong painkillers.
- Wear your compression garment as instructed, neither too loose nor too tight, as explained in our guide to wearing a compression garment after cosmetic surgery.
- Keep dressings clean and dry, and do not soak the wound in a bath, pool or hot tub until your surgeon says it is safe.
- Attend every follow-up appointment so that early problems can be caught.
Our recovery after cosmetic surgery hub has procedure-by-procedure guides, and our article on numbness after surgery covers another common worry in the early weeks.
How We Reduce the Risk of Wound Problems at Centre for Surgery
At Centre for Surgery, wound healing is planned for before the operation, not just managed afterwards. Your consultation includes a review of the factors in this guide, including smoking, weight, diabetes, medicines and previous surgery, and where needed an operation can be postponed until these are in the best possible place. Our GMC-registered plastic surgeons operate at our CQC-regulated Baker Street hospital, under local anaesthetic, sedation or TIVA depending on the procedure, and your wound is checked at your follow-up appointments. The surgeon who assesses you at consultation is the surgeon who performs your surgery, and if you are worried about your wound at any point you can contact the team directly. Our guide to choosing your plastic surgeon explains what aftercare to ask about before you book anywhere.
Frequently Asked Questions
Does dehiscence heal on its own?
Small superficial openings usually heal by themselves from the base upwards with regular dressings, often over one to three weeks. They still need to be seen by your surgical team, so that infection can be ruled out and the right dressing chosen. Full-thickness dehiscence does not heal on its own and needs urgent surgical care.
What causes wound dehiscence?
The commonest causes are tension on the wound and infection. Smoking, diabetes, a high BMI, anaemia, poor nutrition, steroid medicines, coughing and straining all raise the risk, as do operations that remove a lot of skin.
How do you fix dehiscence?
Most superficial dehiscence is cleaned, dressed and left to heal from the base upwards, with antibiotics if there is infection. Larger wounds may be treated with negative pressure dressings or closed a few days later. Full-thickness abdominal dehiscence usually needs a return to theatre.
Can you resuture a dehisced wound?
Not usually straight away, as a wound that has been open for some time may contain bacteria that would be sealed in. A surgeon may close it a few days later once it is clean and healthy, or let it heal and revise the scar later.
Should you cover wound dehiscence?
Yes. Cover it with a clean, dry dressing to protect it from infection and absorb any fluid, then contact your surgical team the same day. Do not try to close it yourself.
When is it too late to stitch a wound?
For fresh cuts, most wounds are stitched within a few hours, and the longer a wound is left open the higher the risk of trapping infection. A surgical wound that has reopened days after an operation is usually managed with dressings instead, with any later closure decided by the surgeon.
What is the difference between wound dehiscence and evisceration?
Dehiscence is the separation of the wound edges. Evisceration is a rare complication of full-thickness abdominal dehiscence in which organs push out through the wound. It is an emergency: cover it with a clean damp dressing and call 999.
How common is wound dehiscence?
It varies widely with the type of operation and the patient’s risk factors. Small areas of superficial breakdown are relatively common after operations that remove a lot of skin, such as tummy tucks and breast reductions, while full-thickness dehiscence after cosmetic surgery is rare.
Can wound dehiscence happen after a C-section?
Yes. A caesarean wound can open in the same way as any other surgical wound, most often in the first two weeks. Contact your midwife, GP or the maternity unit the same day if a C-section wound opens. If an old caesarean scar later bothers you, our guide to tummy tuck after a C-section explains the options.
Worried About Healing After Surgery?
If you are planning surgery and want to understand your own risk of wound problems, or you would like advice about a scar after a wound that opened, a consultation is the right place to start. Our team will go through your health, your operation and your recovery plan with you.
Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation
References
- Sandy-Hodgetts K, Carville K, Leslie GD. Determining risk factors for surgical wound dehiscence: a literature review. International Wound Journal 2015;12(3):265–275. doi:10.1111/iwj.12088 ↗
- Sandy-Hodgetts K, Carville K, Leslie GD. Surgical wound dehiscence: a conceptual framework for patient assessment. Journal of Wound Care 2018;27(3):119–126. doi:10.12968/jowc.2018.27.3.119 ↗
- van Ramshorst GH, Nieuwenhuizen J, Hop WCJ, et al. Abdominal wound dehiscence in adults: development and validation of a risk model. World Journal of Surgery 2010;34(1):20–27. doi:10.1007/s00268-009-0277-y ↗
- Sørensen LT. Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Archives of Surgery 2012;147(4):373–383. doi:10.1001/archsurg.2012.5 ↗
- Martin ET, Kaye KS, Knott C, et al. Diabetes and risk of surgical site infection: a systematic review and meta-analysis. Infection Control and Hospital Epidemiology 2016;37(1):88–99. doi:10.1017/ice.2015.249 ↗
- Parvizi D, Friedl H, Wurzer P, et al. A multiple regression analysis of postoperative complications after body-contouring surgery: a retrospective analysis of 205 patients. Obesity Surgery 2015;25(8):1482–1490. doi:10.1007/s11695-014-1559-5 ↗
- Marchica P, Costa AL, Brambullo T, et al. Retrospective analysis of predictive factors for complications in abdominoplasty in massive weight loss patients. Aesthetic Plastic Surgery 2023;47(4):1447–1458. doi:10.1007/s00266-022-03235-5 ↗
- Zhang MX, Chen CY, Fang QQ, et al. Risk factors for complications after reduction mammoplasty: a meta-analysis. PLOS ONE 2016;11(12):e0167746. doi:10.1371/journal.pone.0167746 ↗
- Norman G, Shi C, Goh EL, et al. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database of Systematic Reviews 2022;4(4):CD009261. doi:10.1002/14651858.CD009261.pub7 ↗
